EMDI Program Guide v3.7


The EMDI Program Guide is intended for healthcare providers and stakeholders who are interested in participating in the EMDI program. These organizations should have the capability to build the architecture and the supporting infrastructure necessary for interoperability. The primary intended audiences are healthcare providers, such as hospitals, physicians, Home Health Agency (HHA) services, Durable Medical Equipment, Prosthetic, Orthotic, & Supplies (DMEPOS), labs, comprehensive primary care networks such as Comprehensive Primary Care Plus (CPC+), and virtual physician networks. Other audiences include:

  • Document transfer vendors, such as Health Information Handlers (HIH), Heath Information Service providers (HISP), and clearinghouses.
  • Interface Vendors, such as Electronic Health Records (EHR) and document management system vendors.
  • Other payers, such as Medicaid State Agencies and commercial payers.
  • IT vendors involved in facilitating the physician’s digital signature on medical record documents.
  • Suppliers and ambulance providers

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The goals for the EMDI program are to:

The goal of EMDI is to ‘Reduce Provider Burden’. EMDI program obtains this goal by harmonizing Health IT standards to achieve interoperability and establishing a secure communication between providers to share structured electronic medical documentation.

To achieve this goal, following objectives have been identified:

  • Process Perspective:
    • Improve medical document sharing
    • Automate manual processes
    • Improve provider workflow
    • Reduce claims re-submission
  • Financial Perspective:
    • Reduce time
    • Reduce cost
    • Reduce resources
  • Provider Perspective:
    • Improved provider-to-provider communication
    • Provider’s satisfaction
  • Growth Perspective:
    • Expansion of EMDI beyond pilot
    • Additional use cases for EMDI workflow

To achieve these goals, CMS will:

  • Develop and maintain the EMDI Program Guide containing the content specifications and transport specifications needed for EMDI pilots and implementations.
  • Identify and fill in the gaps in the current standards to achieve an increased level of interoperability among providers.
  • Encourage EMDI participants with others to conduct pilots.
  • Demonstrate the utility of standards by establishing pilot programs with existing health information handlers, health information service providers, document transfer vendors, interface vendors, healthcare organizations, and healthcare providers.
  • Facilitate the implementation of secure transport of interoperable electronic medical documentation and help overcome barriers faced by organizations during the pilot implementation.
  • Define and collect data for measures to determine the success of the pilot program.

  File Modified
Microsoft Word Document EMDI_Program_Guide.docx Oct 14, 2019 by Ray Wilkerson

Revision Log




Modified By


Section 1.4: CMS and Other Industry Efforts in Interoperability

Section 1.4.1: HL7 Da Vinci

Section 1.4.2: DME eRx Pilots with EMDI

Section 1.4.3: ONC FHIR at Scale Taskforce (FAST)

Section 1.8.4: FHIR based technologies

Section 4: EMDI Related Programs and Initiatives

Section 4.3: CMS and HL7 Initiatives

Section 4.4: Alternative DME Electronic Order System

Appendix H: EMDI FHIR Implementation Guidance


Global: Renamed EMDI Implementation Guide to EMDI Program Guide.

Global: Removed unnecessary capitalization and acronyms to be consistent.

Global: Verified links and section links.

Global: Removed EMR reference from all sections.

Global: Rearranged sections for improved flow.


Global: Added cross-reference for all sections

Global: Verified acronym naming convention

Global: Restructure the Use Case section for improved flow

Global: Verified all links are valid and accurate

Nandini Ganguly

Revision Log




Modified By



Initial Draft



Updated based on direct edits and comments from Melanie Combs-Dyer

10/26/20160.3QA review
11/03/20160.4Continued updates based on information provided by CMS and software vendors
11/10/20160.5Updates based on comments from Hyland and CIOX Health.  Updates in general for various TBD items 

Added LOINC codes for documentation requests

03/03/20170.7Updated the Implementation Guide to an XLC template and address the comments from stakeholders, Included updated data elements and XLM sample code.
04/07/20171.0Updated IG with FHIR related content as well refined the content. Made some corrections and formatting changes. Updated Single schema with few elements updated. 
05/05/20171.1Updated the guide with comments from CMS and data standards SME.
05/19/20172.0Combined HHA and DME versions to make a common Implementation Guide for both. Changed the version to be 2.0 as it’s a major change. 
06/16/20172.1Added Appendix J for FHIR Implementation Guide. Added identified list of resources. 
07/21/20172.2Added sections regarding Appropriate Use Criteria (AUC), Section 2.1.4., Section 3.1.5, Section 4.2. Appendix L and Appendix N have been updated.
08/18/20172.3Update language in assumptions around EMDI requirements that may vary per organization existing system and infrastructure. Changes made in section 3.1.1 and 2.2.2
09/18/20172.4Update language in the section 3.1.1 Assumptions to include Compliant and Striving pilots definitions.  

Section for Signatures has been added under Assumptions in Section 3.1.6 and under Pilot Implementation Overview in Section 4.3.

Section 5.4 Contributors has been added to recognize external contributors of IG

Section 5.5 Points of Contact has been moved at the end of Section 5 and has been updated with contacts for eClinical template workgroup. Also, Table 13 has been updated with current EMDI Project Manager and a new resource.

11/30/20172.6Section 1.3 Additional Considerations has been added to Section 1 Introductions to include a reference to the ONC Interoperability Standards Advisory.

Section 2.3.3 Structured Formats with details for CCDA and CDP1.

Appendix N: Referenced Documents for CCDA has been added

Appendix L: Acronyms for CCDA and CDP1 has been updated

Section 5.4: Contributors has been updated


Section 2.1.5: DME eOrder System section has been added to specify criterias for DME eOrder system

Section 2.3: Standards and Protocols has been updated

Appenxix G: CMS Suggested Clinical Data Elements

Section 5.5 Points of Contact has been updated to add Vidya Sridhar’s information


Global: Rearrangement of Implementation Guide sections

Global: Improvement for accuracy of information

Global: Removed Pilot Guidance from Implementation Guide. Will be delivered as a separate guide

Global: Removed the Prior Authorization and Pre- Claim section

Section 2: EMDI use cases moved to overview section

Section 2.2: Revised Use case workflow sequence diagrams to capture acknowledgements accurately

Section 2.2.1: Updated the workflow of service delivery in use case 1

Section 2.4: Revised standards and protocols section

Section 4: Updated Assumptions/Constraints/Risk section

Section 5: Grouped Clinical templates, AUC, and DME eOrder System under ‘Other suggested programs and functionality’

Section 5.2: Combined Appropriate use program information in one section

Appendix B: Added Signature data block and removed beneficiary and subscriber data block from metadata elements.



Global: Rearrangement of Implementation Guide sections

Global: Updated language from ‘recommended standards/formats’ to ‘identified standards/formats’

Global: Include Hospice Care as a provider

Global: Remove Laboratory Testing as a provider

Section 1: Updated the Introduction to include the goal of reducing provider burden

Section 1.3: Added language for the Overarching Goals of Promoting Interoperability and the 21st Century Cures Act

Section 2.3: Updated content for Interface vendors and Document Transfer Vendors (HIH/HISP/Clearinghouse)

Section 3.2: Removed organization names for EHR, Document Management, and HIH System options

Section 3.3: Removed language for Standards

Added content to the Introduction section that reference the HITECH Act

Updated 'Additional Considerations’ to enhance the flow of the section/language

Updated language on the EMDI Overview

Included assumptions for EMDI use cases

Reorganized the structured of the IG to include Pilot Participants before Use Case

EMDI Identified Standards and Implementation Specification: Included language to differentiate the standards

Direct: Updated language and included link to Direct Trust site

Connect: Included link to Connect site

Content Standard: Included language to describe its relevance to EMDI. Included additional language relevant to APIs

Messaging Data Standards: Included language that speaks to relevance of this standard for EMDI

X12: Updated language for relevancy of how it used by EMDI stakeholders

Signatures: Included additional language about the importance of signatures

Updated Implementation Standard and Security to Pre-Pilot Conditions

Removed acronym ‘CDE’ to minimize confusion

LOINC Code: Updated language for relevance to EMDI


Section 2.4.2: Content Standards: Definition of structured medical document added

Section 2.6.2: Digital Signatures

Section 3.4: Risks, Issues and Constraints

Section 4.0: Metadata elements



Section 2.1: EMDI Purpose

Section 2.1.3: How does EMDI fulfill this gap

Section 3.1: EMDI Program Assumptions

Section 3.2: Use Case Assumptions

Section 5.4: HL7 Da Vinci DME Order Use Case using FHIR

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